A weekly ECG / EKG review blog looking at some interesting ECG's from the world of Emergency Medicine.
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Wednesday, 1 March 2017

ECG of the Week - 27th February 2017 - Interpretation

The following ECG is from a 55yr old male who is having episodes of chest pain with increasing frequency.

Click to enlarge

﻿Rate:

108 bpm

Rhythm:

Regular

Sinus rhythm

Axis:

Normal

Intervals:

PR - Normal (160-180ms)

QRS - Normal

QT - 300ms

Segments:

Up-sloping ST segment in lateral precordial leads

Additional:

Prominent T waves leads II, aVF, V6

In relation to QRS magnitude

Low QRS voltage

No electrical alternans

Baseline artifact affecting leads V4-6 and end of rhythm strip

Interpretation:

Prominent T waves in the setting of chest pain are concerning for ACS

Requires serial ECG's looking for progressive ST segment change

Combination of low voltage & tachycardia should prompt consideration of pericardial effusion as a cause for the chest pain.

As with all ECG's the ECG features need to be considered in the patient's specific clinical context

What happened ?The patient was admitted for investigation under the cardiology team. Serial troponins and D-dimer were negative and an angiogram showed only minor vessel irregularities. Causes of Low Voltage ECGWhilst pericardial effusion / tamponade is the most serious cause of ECG low voltage it is not the only cause or the most common. Causes include: